Case report: Rare case Pandoraea ssp causing bacteremia associated with CRBSI in patients with hydrocephalus post intraventricular hemorrhage drain revision at Prof. Ngoerah Hospital, Denpasar, Bali

Introduction: Pandoraea species is a multidrug-resistant, gram-negative bacillus usually isolated from patients with cystic fibrosis (CF) and also commonly found in water and soil. Bloodstream infection with Pandoraea ssp in non-CF patients is uncommon. We report the first case of post-revision VP shunt hydrocephalus with bacteremia and associated CRBSI caused by Pandoraea ssp.

Case description: A 50-year-old Balinese man with underlying disease of sepsis by Pandoraea ssp. after several histories of surgery, a patient with non-communicating hydrocephalus and intraventricular hemorrhage after endoscopic Intra Ventricular Hemorrhage evacuation and revision of the proximal shunt. The patient complained of being unconscious for 2 days, slurred speech, weakness in half of the body, vomiting once, seizures, and a fever. The CVC device was installed for 20 days, and he had a fluctuating fever during the hospitalization. Ceftriaxone and levofloxacin were given intravenously for empiric treatment. Pandoraea ssp. were isolated from both his blood samples and exit site; once the pathogen and drug sensitivity were confirmed, levofloxacin was planned for definitive treatment. One month after the patient was admitted, his condition worsened and he was pronounced dead.

Discussion: Pandoraea ssp. had been reported in this patient with multiple organ dysfunction as a complicating factor. In our case, the potential source of this bacteria was considered to be contamination from the environment. This infection is considered CRBSI during hospitalization. This bacteria is multi-drug-resistant, which makes treatment of Pandoraea infections complicated.

Conclusion: The finding case will be beneficial to clinicians because it provides additional information about the lesser-known Pandoraea species.